Leveling and Alignment in E.W.A / Orthodontic Courses by Indian Dental Academy

Bracket Positioning,
Sequence of Mechanics
in
Edgewise Mechanics

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com
Bracket Positioning,
Sequence of Mechanics
in
Edgewise Mechanics
Dr. OP har!anda, "##MS, $ew Delhi
Basics of Edgewise
Dr. O. P. Kharbanda
All India Institute of Medical Sciences
opk15@hotmail.com ompk@aiims.ac.in
Dr. Ashok !ena
Dr. Sandip Kumar
Dr. Pri"anka Kapoor
Dr. #ari
Dr. $eera% &adha'an
Dr. (ishal )upta
Dr. Anand Pal *ohia
+ontributors
%rowth trends
&
'y(e " growth trend
&
'y(e B growth trend
&
'y(e ) growth trend
'y(e " growth trend
*
'he middle and lower face are growing forward and
downward in unison, with no change in si+e of the "$B
*
%rowth is a((ro,imately equal in !oth the -ertical and
hori+ontal dimensions
*
"((ro,imately ./ 0 of (atients
'y(e B growth trend
*
%rowth downward and forward with the middle face
growing forward more ra(idly than the lower face
*
%rowth of the middle and lower face is (redominantly in the
-ertical dimension in most instances
*
"$B reading 1
2
to 3.
2
*
#f "$B is less than 4
2
(rognosis is fair
*
#f "$B is 5
2
to 3.
2
(rognosis is (oor
*
E,traction of all four first (remolar mandatory for (atients
with high "$B angle
*
Only a!out 3/0 (atients
'y(e ) growth trend
*
Lower face is growing downward and forward more ra(idly than
the middle face with a decreases in "$B angle
*
6hen 7M" ranges u(ward from .2
2
, growth is a((ro,imately
equal in the -ertical and hori+ontal dimensions
*
6hen 7M" .2
2
or less, growth (redominantly hori+ontal
*
6hen growth is -irtually confined to the hori+ontal dimension
with little -ertical growth, the growth trend is classified as 'y(e )
su!di-ision.
*
120 (atients ha-e 'y(e ) growth trend
"nchorage
*
'ooth anchorage 8"nchorage (re(aration9
*
"nchorage sa-ers
Anchorage preparation
*
3
st
degree
*
.
nd
degree
*
:
rd
degree
Anchorage savers
*
;eadgear or (alatal !ar
*
$ance !utton
*
Delayed e,traction
*
Li( !um(ers
*
Muscular (attern of low 7M" cases
Anchora,e sa-ers Dr. OP har!anda
Bracket (lacement
*
Precision !racket (lacement is essential for good le-eling
and alignment.
*
#ndirect !onding showed !etter !racket (lacement. 8Koo,
Chung, Vanarsdall, 1999)
*
Light cure !onding also showed !etter !racket (lacement
than chemical cure.
*
Bonding with orthocad technology shows more accurate
!racket (ositioning.
Bracket (lacement
'weed< Mandi!ular arch<
*
Bracket slot should !e :./mm from incisal edge or cus(al ti(
*
On molars =Between occlusal and middle third
Ma,illary arch<
*
Bracket slot :./mm from incisal edge of cus(al ti( e,ce(t on lateral
incisor 8:.2mm9
Dr. OP har!anda, "##MS, $ew Delhi, 'y(o Photos )ourtesy Dr. ;ari P% student
Bracket (lacement
Lindquist:
Upper arch Lower arch
Central !"## !$##
Lateral !$## !$##
Canine "!$## !"##
%re#olar !"## "!$##
Molar &!"## !$##
)om(uteri+ed !onding
*
%enerating digital information defining the sha(e and
location of the malocclused tooth with res(ect to the (atient>s
?aw
*
%enerating a mathematical model of the malocclused tooth
as (ositioned in the ?aw from the digiti+ed information
*
)alculating the finish (osition in the ?aw to which the
malocclused tooth is to !e mo-ed from the digiti+ed
information
)om(uteri+ed !onding
*
)alculating the (lacement (osition of an orthodontic
!racket on the malocclused tooth required in order to
mo-e the malocclused tooth to its finish (osition !y a
(reselected orthodontic treatment
*
" standard !racket is thereafter modified, if desired,
indi-idually for the (atient, in -iew of the (atient>s
(hysical de-iations from the statistical a-erages.
*
'he sha(e of a !racket (ositioning ?ig is calculated and
formed
"L#%$ME$' @ LEAEL#$%
'oals o( (irst phase
*
Bring the teeth in alignment and correct -ertical
discre(ancies !y le-eling out the arches
*
La!iolingual discre(ancies 8cross!ites9
*
",ial discre(ancies 8mesio=distal9
*
)orrect rotations
Loo( mechanics
*
" loo( reduces force and increases range !y adding wire
in inter=!racket s(an.
*
" loo( may !e o(en or closed ty(e.
*
O(en loo(s are most efficiently acti-ated through
com(ression of the legs.
*
'he force of any loo( may !e reduced !y coiling the
wire at the a(e, one or more times.
*
'he force de-elo(ed in loo( or arch wire is transmitted
to the tooth through the !racket attachment resulting
tooth mo-ement.
)linical a((lications of loo(s
Move#ents Loop
La!ial = Dou!le -ertical= o(en
Lingual = Dou!le -ertical= o(en
Ele-ation = Dou!le hori+ontal or Bo,
De(ression = Dou!le hori+ontal or Bo,
Botation = Dou!le -ertical= o(en or !o,
Boot ti((ing= Bo, or dou!le hori+ontal
)anine Betraction & Bicketts S(ring
#ncisor Betraction ' loo(s Cdou!le key hole loo(s

)linical a((lications of loo(s
3. Mesial or distal mo-ement 8such as midline correction9< dou!le
-ertical loo( against !racket or fi,ed to the contained section of
the arch, acti-ated !y tying !ack or com(ression. )om!ination of
o(en and closed -ertical loo(s.
.. S(ace closure 8contraction of the arch9< closed -ertical loo(, tied
!ack.
:. S(ace o(ening 8e,(ansion of the arch9< o(en -ertical loo(, with
sto(s.
4. Bite o(ening< '=loo(s mesial to the canine. $ote that the arch
wire in anterior section !etween the two loo(s should ha-e
re-erse cur-e to transmit the (ressure equally to all 4 incisors.
Princi(les in the choice of alignment arches
*
#nitial arch wires for alignment should (ro-ide light, continuous
forces to (roduce the most effecti-e tooth mo-ement. ;ea-y
force in contrast should !e a-oided.
*
'he arch wire should !e a!le to mo-e freely within the !rackets.
7or mesiodistal sliding along an arch wire, at least . mil
clearance !etween the arch wire and !racket is needed, and 4 mil
clearances is desira!le.
Princi(les in the choice of alignment arches
*
Bectangular wire (articularly those with a tight fit within the !racket
slot so that the (osition of the root a(e, could !e affected, normally
should !e a-oided. )u((er $i 'i or Bio7orce are the e,ce(tions.
*
Bound wires are (referred for alignment.
Multiple loop arch wire (0.016)
Molar tie back,Vertical loops, L loops
Upper
Lower
Dr. OP har!anda, "##MS, $ew Delhi, 'y(o Photos courtesy Dr.;ari P% student
Multiple loop arch 'ire after li,ation
Multiple loop arch 'ire after mo-ement
Leveling with 0.016 rch wire
Molar stops
!irst or"er ben"s
#econ" or"er ben"s
upper
lower
0.016 rch wire a$ter ligation
0.016 rch wire a$ter %ove%ent
Leveling with 0.01& rch wire
Molar stops, !irst or"er ben"s, #econ" or"er ben"s
'urve o$ spee( upper, )everse curve o$ spee( lower
."pical /pper and lo'er le-elin, 'ire
often used in 0d,e'ise appliance %ust before
Insertion of the 0d,e'ise 'ire.
Mild cur-e of Spee
&ith tip back bends and
Molar stops
Mild 1e-erse cur-e of Spee
&ith tip back bends and
molar stops
Le-eling with 2.2.2D "rch wire
*
Molar sto(s
*
7irst order !ends
*
Second order !ends
*
)ur-e of s(ee= u((er
*
Be-erse cur-e of s(ee= lower
"cknowledgement
Sincere thanks to all those staff , P% students, )ME' Staff and all
others who ha-e directly or indirectly contri!uted to this
(resentation
'hank you
7or more details (lease -isit

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